结核性脑膜炎预后预测因素分析  

Evaluate factors predicting prognosis of tuberculous meningitis

作　　者：龚思引 罗海彦[1] 吴禹[1] 

机构地区：[1]重庆医科大学附属第二医院神经内科,重庆400010

出　　处：《中国热带医学》2016年第3期269-272,共4页China Tropical Medicine

摘　　要：目的分析结核性脑膜炎预后的预测因素,为结核性脑膜炎诊治临床决策的制定提供依据。方法纳入2011年1月—2015年12月期间于重庆医科大学附属第二医院神经内科住院治疗的结核性脑膜炎患者,用多因素Logistic回归分析方法对结核性脑膜炎预后的预测因素进行分析。结果共纳入106例患者,预后良好组（m RS 0～2）66例,预后不良组（m RS 3～6）40例。年龄（OR=1.111,95%CI：1.056～1.168,P〈0.001）、癫痫（OR=6.857,95%CI：1.263～37.229,P=0.026）、脑MRI异常（OR=7.671,95%CI：2.025～29.052,P=0.003）、颅外结核（OR=15.244,95%CI：3.205～72.507,P=0.001）为结核性脑膜炎预后不良的独立危险因素,CSF葡萄糖（OR=0.324,95%CI：0.121～0.869,P=0.025）为结核性脑膜炎预后不良的独立保护因素。结论年龄、癫痫、低CSF葡萄糖、脑MRI异常、颅外结核是结核性脑膜炎预后不良的独立预测因素,对预测因素的识别有助于制定更适宜的临床决策以改善结核性脑膜炎患者的临床结局。Objective To evaluate factors predicting the prognosis of tuberculous meningitis（TBM） to assist withdiagnostic and therapeutic strategy of TBM. Methods Inpatients diagnosed as TBM in the Second Affiliated Hospital ofChongqing Medical University from Jan 2011 to Dec 2015 were included. Predictors of prognosis were analyzed by multivariatelogistic regression analysis. Results A total of 106 participants were included in the study with 66 cases in good clinicoutcome group（m RS 0～2） and 40 patients in poor clinic outcome group（m RS 3～6）. Age（OR=1.111,95% CI：1.056～ 1.168,P0.001）, epilepsy（OR=6.857,95% CI：1.263～37.229,P=0.026）, abnormal brain MRI（OR=7.671,95% CI：2.025～29.052,P=0.003）and extra-cranial tuberculosis（TB）（OR=15.244,95% CI：3.205～72.507,P=0.001）were independent risk factors forpoor outcome of TBM, while CSF glucose（OR=0.324,95% CI：0.121～0.869,P=0.025）was an independent predictor forfavorable outcome of TBM. Conclusion Age, epilepsy, low CSF glucose, abnormal brain MRI and extra-cranial TB wereindependent risk factors of poor outcome with TBM. Recognition of the predictors can assist with therapeutic strategy so as toimprove the clinical outcome of patients with TBM.

关 键 词：结核性脑膜炎 预后 预测因素 危险因素 

分 类 号：R529.3[医药卫生—内科学]